Avoiding Legal Trouble While Providing Pain Management Through Opioids
Pain is the leading reason people visit a doctor. A recent report from the Centers for Disease Control and Prevention (CDC) estimated that 51.6 million adults in the United States (20.9%) suffer from chronic pain, while 17.1 million (6.9%) experience high-impact chronic pain that significantly limits daily activities and causes considerable suffering.
Despite the increasing demand for pain treatment, physicians and medical students in the United States receive limited training in pain management. This can lead not just to difficulties in providing effective treatment, but also potentially putting patients at risk, specifically when opioids are involved. Managing chronic pain comes with a unique set of legal risks for healthcare providers, especially in the context of opioid use and controlled substances. Pain management clinics, or medical practices that treat patients with long-term pain through medication, among other treatments, must carefully navigate legal and regulatory frameworks to avoid potential liabilities. Here is what pain management clinics should consider when thinking about their legal risks with respect to opioids.
Epidemic of Opioid Abuse
Opioid abuse is a significant problem. According to the National Institute on Drug Abuse, drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029. While opioids enter the country illegally, some of these drugs are acquired legally from prescribers who oftentimes unwittingly prescribe opioids to patients who they believe to be in significant pain. Unfortunately, patients can be dishonest about the extent of their pain. This is why prescribers of opioids need to be very careful in deciding to use opioids in pain management.
Laws Governing Opioids
Both federal and state law govern the use and prescription of opioids. At the federal level, agencies like the Drug Enforcement Administration (DEA) set guidelines for prescribing and monitoring controlled substances. The Controlled Substances Act (CSA) classifies drugs into five schedules based on their potential for abuse, medical use, and safety. Opioids, commonly used in pain management, fall under Schedule II due to their high potential for addiction. Compliance with DEA requirements includes maintaining detailed records, implementing secure storage for medications, and reporting suspicious activities.
State laws add another layer of complexity. Each state has its own medical boards and regulations governing pain management practices. Georgia has a Prescription Drug Monitoring Program (PDMP). All Georgia prescribers must be registered in the PDMP. Prescribers are mandated to check the PDMP before dispensing benzodiazepines or Schedule II opiate/cocaine derivatives.
Legal Risks of Overprescribing Opioids
Criminal Liability: Overprescribing opioids without a legitimate medical need can result in criminal charges under the CSA. In extreme cases, providers can face felony charges for drug trafficking if they are found to be distributing medications with the intent to misuse them.
Medical Malpractice and Civil Liability: If a patient misuses prescribed medications or overdoses, the provider could be held liable for medical malpractice. Failing to properly assess the risks of addiction or not adhering to best practices for opioid prescriptions can lead to lawsuits.
Loss of Medical License: Regulatory bodies, such as the Drug Enforcement Administration (DEA) and state medical boards, monitor prescription patterns for controlled substances. A pattern of overprescribing or failure to follow the CDC’s opioid prescribing guidelines can lead to investigations, loss of prescribing privileges, and even the revocation of a medical license.
Avoiding Legal Complications
Establishing best practices can help pain management clinics and practitioners to avoid legal trouble. Here are some of the best practices to put in place to minimize legal risk in prescribing opioids for pain management.
Thorough Patient Evaluation
One of the most critical aspects of legally prescribing opioids is ensuring thorough patient evaluation and documentation. This includes obtaining a complete medical history, conducting a physical examination, and assessing the patient’s pain level and history of substance use.
Follow Opioid Prescribing Guidelines
To mitigate the risk of legal trouble, healthcare providers should follow established opioid prescribing guidelines. These guidelines emphasize the need for careful patient selection, considering non-opioid pain management options first, and using the lowest effective dose of opioids for the shortest duration necessary. Prescribing opioids should be done with caution and only when the benefits outweigh the risks. Regular follow-up appointments should be scheduled to assess the patient’s response to the medication, the need for continued opioid use, and any signs of misuse or dependence.
Setting Boundaries
Clear communication with patients helps to avoid misunderstandings and protect both the patient and provider. Healthcare providers should establish clear boundaries regarding opioid use, including the expected duration of treatment, the potential for prescription changes, and the steps the patient must take to ensure their safety. The provider should also make it clear that the use of opioids will be closely monitored, with regular check-ups to assess pain management progress, medication adherence, and signs of misuse. A signed agreement, sometimes called an opioid treatment agreement or pain management contract, can help formalize these expectations and serve as a reference point in case of any future issues. This document should outline the responsibilities of both the healthcare provider and the patient, emphasizing the risks of opioid use, including dependency and overdose.
Monitoring Is Key
Once opioids have been prescribed, ongoing monitoring is crucial to ensure they are being used safely and appropriately. Monitoring can involve assessing the patient’s physical and mental health and monitoring for any signs of opioid dependence or misuse. Providers have an ethical and legal obligation to report any suspicions of prescription misuse, diversion, or abuse. This can be difficult, especially when it involves long-term patients with whom the provider has built a rapport. However, failing to report such cases can lead to severe legal consequences and jeopardize the provider’s license. Implementing protocols for reporting and ensuring that all staff members understand their responsibilities can help mitigate this risk.
Contact an Experienced Healthcare Lawyer
While opioids remain a critical component of pain management for many patients, the risk of legal trouble surrounding their prescription cannot be overlooked. Healthcare providers must take comprehensive steps to ensure they are prescribing opioids in compliance with all relevant laws and regulations. Consulting with an experienced healthcare lawyer is crucial for anyone involved in healthcare, but especially those prescribing opioids in this current climate.
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